title: Diaphragmatic hernia after esophagectomy in 440 patients with long-term follow-up.
abstract: BACKGROUND
  Postesophagectomy diaphragmatic hernia (PDH) is a recognized but severely under-reported and potentially hazardous event. Information regarding the natural course of this condition and guidelines regarding indications for reoperative intervention are lacking. In this study we aim to describe the frequency, predictors of incidence, and indications for repair.
  
  
  METHODS
  Cross-sectional imaging (computed tomography scan) from patients who underwent esophagectomy between January 2001 and December 2007 at a single center were reviewed by two radiologists blinded to previous reports and clinical outcomes. Patients with PDH were compared with a similar cohort who did not have hernia. Patient characteristics, outcomes, and hernia descriptors including longitudinal progression were recorded. Multivariable logistic regression analyses identified predictors of PDH and need for repair.
  
  
  RESULTS
  Of a total of 440 patients who underwent esophagectomy, 67 (15%) were radiologically diagnosed with PDH. Of these, only 7 of 67 cases (10%) were prospectively reported by the radiologist. Median time interval from esophagectomy to hernia was 2 years. Type of esophagectomy was an independent predictor for hernia developing (p = 0.027). Patients with high body mass index were less prone to have PDH (p = 0.043). Thus far, 9 patients (2%) have required surgical intervention, all for hernia-related symptoms or progression. Despite mesh repair, 4 of 9 have recurred and 2 were re-repaired. There was 1 PDH-associated death, 8 years after transhiatal resection.
  
  
  CONCLUSIONS
  Variables contributing to PDH are both technical and patient dependent. Whereas the majority of patients with PDH have not required repair, a small portion who became symptomatic or had large, progressive hernia required remedial surgery. Postesophagectomy patients require long-term surveillance for PDH.
authors.affiliation: Department of Radiology, University of Texas, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Dhakshina Moorthy
authors.initials: DM
authors.lastname: Ganeshan
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.affiliation: Department of Radiology, University of Texas, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Priya
authors.initials: P
authors.lastname: Bhosale
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Ara A
authors.initials: AA
authors.lastname: Vaporciyan
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, Texas.
authors.forename: David
authors.initials: D
authors.lastname: Rice
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Reza J
authors.initials: RJ
authors.lastname: Mehran
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Garrett L
authors.initials: GL
authors.lastname: Walsh
authors.affiliation: Department of Radiology, University of Texas, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Revathy
authors.initials: R
authors.lastname: Iyer
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jack A
authors.initials: JA
authors.lastname: Roth
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Swisher
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, Texas. Electronic address: whofstetter@mdanderson.org.
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: 6